42 C.F.R. §§ 456.131–456.137

The committee assigns subsequent continued stay review dates in accordance with §§ 456.128 and 456.134(a);

The committee assigns a subsequent review date each time it decides under § 456.135 that the continued stay is needed; and

The committee ensures that each continued stay review date it assigns is recorded in the beneficiary's record.

The methods and criteria, including norms if used, that the committee uses to assign subsequent continued stay review dates under § 456.133; and

The methods that the committee uses to modify an approved length of stay when the beneficiary's condition or treatment schedule changes.

The committee, subgroup or designee reviews a beneficiary's continued stay on or before the expiration of each assigned continued stay review date;

For each continued stay of a beneficiary in the hospital, the committee, subgroup or designee reviews and evaluates the documentation described under § 456.111 against the criteria developed under § 456.132 and applies close professional scrutiny to cases selected under § 456.129(b);

If the committee, subgroup, or designee finds that a beneficiary's continued stay in the hospital is needed, the committee assigns a new continued stay review date in accordance with § 456.133;

If the committee, subgroup, or designee finds that a continued stay case does not meet the criteria, the committee or a subgroup that includes at least one physician reviews the case to decide the need for continued stay;

If the committee or subgroup making the review under paragraph (e) of this section finds that a continued stay is not needed, it notifies the beneficiary's attending physician and gives him an opportunity to present his reviews before it makes a final decision on the need for the continued stay;

If the attending physician does not present additional information or clarification of the need for the continued stay, the decision of the committee or subgroup is final; and

If the attending physician presents additional information or clarification, at least two physician members of the committee review the need for the continued stay. If they find that the beneficiary no longer needs inpatient hospital services, their decision is final.

The hospital administrator;

The attending physician;

The Medicaid agency;

The beneficiary; and

If possible, the next of kin or sponsor.

The committee makes a final decision on a beneficiary's need for continued stay and gives notice under § 456.136 of an adverse final decision within 2 working days after the assigned continued stay review dates, except as required under paragraph (b) of this section.

If the committee makes an adverse final decision on a beneficiary's need for continued stay before the assigned review date, the committee gives notice under § 456.136 within 2 working days after the date of the final decision.